Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study

Pisarska, Magdalena; Pędziwiatr, Michał; Małczak, Piotr; Major, Piotr; Ochenduszko, Sebastián; Zub-Pokrowiecka, Anna; Kulawik, Jan; Budzyński, Andrzej

doi:10.1016/j.ijsu.2016.11.088

Cited by 103 publications

(85 citation statements)

References 24 publications

(27 reference statements)

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“…Cakir et al [24] also reported that strict adherence to the ERAS protocol resulted in lower LOSH and improved outcomes in colon surgery for malignancy. In colorectal laparoscopic surgery, Pisarska et al [25] reported consistent findings by showing that improvement of protocol compliance leads to better treatment results and convalescence parameters, even when groups with high and very-high compliance rate are compared. Pisarska et al [25] only analyzed short-term results, whereas Gustafsson et al [26] demonstrated that the risk of 5-year cancer-specific death in colorectal cancer is lower by 42% in groups with ≥ 70% compliance in comparison to <70%.…”

Section: Outcomes Colonic Surgerymentioning

confidence: 80%

“…In colorectal laparoscopic surgery, Pisarska et al [25] reported consistent findings by showing that improvement of protocol compliance leads to better treatment results and convalescence parameters, even when groups with high and very-high compliance rate are compared. Pisarska et al [25] only analyzed short-term results, whereas Gustafsson et al [26] demonstrated that the risk of 5-year cancer-specific death in colorectal cancer is lower by 42% in groups with ≥ 70% compliance in comparison to <70%. Although this last study demonstrates a striking relationship between adherence to protocol and cancer survival, this may not imply a cause and effect association between them -the study doesn't present evidence of mechanisms behind this effect.…”

Section: Outcomes Colonic Surgerymentioning

confidence: 80%

“…Even in centers that use ERAS protocols on a routine basis, compliance rate round 60-80% [25]. Many studies do not specify the compliance rate of the ERAS protocols and, between the ones who do, there is lack of uniformity in compliance definitions, which are frequently defined by different cutoff points for common analyzed parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies do not specify the compliance rate of the ERAS protocols and, between the ones who do, there is lack of uniformity in compliance definitions, which are frequently defined by different cutoff points for common analyzed parameters. A good example of this lies in the definition of early mobilization, which is subjectively determined by authors [25]. A lack of standardization may result in bias when trying to evaluate overall compliance rates.…”

Section: Discussionmentioning

confidence: 99%

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Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Tintim¹,

Machado²

2017

J Anesth Clin Res

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Section: Outcomes Colonic Surgerymentioning

confidence: 80%

Section: Outcomes Colonic Surgerymentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Tintim¹,

Machado²

2017

J Anesth Clin Res

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“…All patients had the exact same perioperative care ERAS protocol (Table 1), which has been used in our department for 5 years. Mean compliance with the protocol is over 80% [17]. …”

Section: Methodsmentioning

confidence: 99%

Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol

et al. 2018

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Background Combination of laparoscopic approach with ERAS protocol in colorectal surgery allows for an early discharge. However there is a risk that some of the discharged patients are developing, asymptomatic at the time, infectious complications. This may lead to a delay in diagnostics and proper treatment introduction. We aimed to assess the usefulness of preoperative plasma albumin concentration and their changes as indicators of infectious complications in patients undergoing colorectal cancer surgery. Methods Prospective analysis included 105 consecutive patients who underwent laparoscopic colorectal cancer resection between August 2014 and September 2016. In all cases standardised 16-item perioperative care ERAS protocol was used (mean compliance > 85%). Patients with IBD, distant metastases, undergoing emergency or multivisceral resection were excluded. Blood samples were collected preoperatively and on POD 1, 2, 3. Plasma albumin concentration was measured. Patients were divided into two groups depending on the presence of infectious complications. We analysed the differences in the levels of albumin and the dynamics of changes. Results Group 1-82 not complicated patients, Group 2-23 patients with at least one infectious complication. Preoperatively, there were no significant differences in the levels of serum albumin between those groups (Group 1-38.7 ± 4.9 g/l; Group 2-37.7 ± 5.0 g/l). In postoperative period, decrease was observed in both (POD 1: Group 1-36.5 ± 4.2 g/l, Group 2-34.7 ± 4.2 g/l, p = 0.07; POD 2: Group 1-36.2 ± 4.1 g/l, Group 2-32.6 ± 5.6 g/l, p = 0.01; POD 3: Group 1-36.0 ± 4.4 g/l, Group 2-30.9 ± 3.5 g/l, p = 0.01). The decrease was significantly greater in Group 2 on POD 2 and 3. Conclusions We showed that a regular measurement of albumin in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Although changes in albumins are observed early after surgery, this parameter is relatively unspecific. Keywords Colorectal cancer · Laparoscopy · Infectious complications · Markers · AlbuminsColorectal cancer surgery is associated with a relatively high morbidity rate, which depends on multiple factors and can occur in 30-40% of patients [1,2]. One of the significant components affecting those parameters is the surgical technique. It has been shown that the laparoscopic approach is correlated with reduced morbidity [3,4]. Moreover, the implementation of multimodal perioperative care protocols enhanced recovery after surgery (ERAS) further decreases postoperative complications by approximately 20-40% and leads to early hospital discharge after 2-5 days [5][6][7][8]. These factors markedly shortened length of stay (LOS). Some complications (i.e. anastomotic leakage) can occur late after surgery, even on postoperative day (POD) 8-12. This and Other Interventional Techniques

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Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

et al. 2023

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ImportanceEnhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.ObjectiveTo integrate the 2 tools to facilitate key perioperative decision-making.Evidence ReviewSnowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022.FindingsRound 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs.Conclusions and RelevanceThe SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.

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Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study

Abstract: Full implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.

Cited by 103 publications

References 24 publications

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

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